• Gregory Glauser, Matthew Piazza, Ian Berger, Benjamin Osiemo, Scott D McClintock, Eric Winter, H Isaac Chen, Zarina S Ali, and Neil R Malhotra.
• Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
• Neurosurgery. 2020 Feb 1; 86 (2): E140-E146.

BackgroundAs the use of bundled care payment models has become widespread in neurosurgery, there is a distinct need for improved preoperative predictive tools to identify patients who will not benefit from prolonged hospitalization, thus facilitating earlier discharge to rehabilitation or nursing facilities.ObjectiveTo validate the use of Risk Assessment and Prediction Tool (RAPT) in patients undergoing posterior lumbar fusion for predicting discharge disposition.MethodsPatients undergoing elective posterior lumbar fusion from June 2016 to February 2017 were prospectively enrolled. RAPT scores and discharge outcomes were recorded for patients aged 50 yr or more (n = 432). Logistic regression analysis was used to assess the ability of RAPT score to predict discharge disposition. Multivariate regression was performed in a backwards stepwise logistic fashion to create a binomial model.ResultsEscalating RAPT score predicts disposition to home (P < .0001). Every unit increase in RAPT score increases the chance of home disposition by 55.8% and 38.6% than rehab and skilled nursing facility, respectively. Further, RAPT score was significant in predicting length of stay (P = .0239), total surgical cost (P = .0007), and 30-d readmission (P < .0001). Amongst RAPT score subcomponents, walk, gait, and postoperative care availability were all predictive of disposition location (P < .0001) for both models. In a generalized multiple logistic regression model, the 3 top predictive factors for disposition were the RAPT score, length of stay, and age (P < .0001, P < .0001 and P = .0001, respectively).ConclusionPreoperative RAPT score is a highly predictive tool in lumbar fusion patients for discharge disposition.Copyright © 2019 by the Congress of Neurological Surgeons.

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